A clinical and molecular analysis of Candidozyma auris strains from Romania, 2022-2023

Abstract

Candidozyma auris (formerly Candida auris; C. auris) raises significant concerns for healthcare facilities due to its ability to cause severe systemic infections, increased resistance to antifungals, and high intra-hospital transmissibility. We conducted a retrospective study on 102 patients diagnosed in 2022 and 2023. Demographic, clinical, and epidemiologic data were collected from the hospital databases. C. auris was identified using MALDI-TOF systems, and antifungal susceptibility was determined with Micronaut. The isolates were sequenced using Illumina next-generation sequencing platforms. Molecular epidemiology analysis was performed with multiple bioinformatics approaches (phylogenetic tools, resistance genes-related predictions, and variant analyses). Most patients (80/102) were admitted to or had been recently transferred from intensive care units at the moment of C. auris detection. Most cases (57/102) were classified as infections; 29 of them were bloodstream infections. All patients had been treated with broad-spectrum antibiotics before C. auris isolation, and 75/102 had received antifungals. All 31 tested isolates showed resistance to fluconazole, 5 were resistant to amphotericin B, and they were all susceptible to echinocandins. Crude mortality for infected patients was 68.18%. The 31 analyzed sequences belonged to clade I and bore multiple resistance markers.IMPORTANCEHighly antifungal-resistant Candidozyma auris keeps spreading in regions previously free of this pathogen, stressing once again the need for active surveillance, flexible control measures, and antimicrobial stewardship. This study is seminal for our understanding of the C. auris outbreak in Romania, providing insights into the evolutionary dynamics and genomic diversity of the pathogen and highlighting clade-specific mutations possibly linked to antifungal resistance. By joining these molecular characteristics with clinical, epidemiological, and microbiology data, such as risk factors for acquiring C. auris and phenotypic antifungal susceptibility, the study can be instrumental for surveillance and infection control strategies that are essential due to the pathogen's high transmissibility and the global health threat that it poses.

Keywords: Candida auris; emergent fungus; healthcare-associated infections.

Fig 1

Phylogenetic relationship between Romanian (blue) and other genomes from clade I, according to the Pathogenwatch database.